Gökçe Nur SAY, Koray KARABEKİROĞLU, Murat YÜCE

Dikkat eksikliği/ hiperaktivite bozukluğu olan çocuklarda metilfenidat yanıtı ile ilişkili faktörler: Retrospektif bir çalışma

Amaç: Bu çalışmada dikkat eksikliği ve hiperaktivite bozukluğu olan çocuklarda (DEHB) klinik özelliklerin ve öz-kavramının metilfenidat (MTF) yanıtı üzerine etkilerinin araştırılması amaçlanmıştır.Yöntem: Çalışma naturalistik desende yapılmış olup sonuçlar geriye dönük olarak değerlendirilmiştir. DEHB ve komorbid bozuklukların tanısı Okul Çağı Çocukları İçin Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi Şimdi ve Yaşam Boyu Şekli-Türkçe Uyarlaması (ÇGDBŞÖ-ŞY) ile konulmuştur. İlk görüşmede ebeveynlere Turgay DSM-IV'e dayalı Yıkıcı Davranış Bozukluklarını Tarama ve Değerlendirme Ölçeği (T-DSM-IVYDDÖ) ve Çocuk ve Gençler için Davranış Değerlendirme Ölçeği (ÇDDÖ) uygulanmıştır. Öğretmenler T-DSMIV-YDDÖ ve ÇDDÖ'ni doldurmuşlardır. Çocuklar ise Piers-Harris'in Çocuklarda Öz-kavramı Ölçeği (PHÇÖÖ), Çocuklarda Depresyon Ölçeği (ÇDÖ) ve Çocuklarda Anksiyete Tarama Ölçeği (ÇATÖ) ile değerlendirilmişlerdir. MTF tedavisini takiben ebeveynlere tekrar T-DSM-IV-YDDÖ uygulanmıştır. DEHB belirtilerindeki düzelme klinisyen tarafından Klinik Global İzlenim-İyileşme ölçeği ile değerlendirilmiştir. Çalışmaya toplam 54 çocuk (18 kız, 36 erkek; yaş ortalaması 9.32±0.21 yıl) dahil edilmiştir. Örneklem yazarlar tarafından belirlenen kriterlere göre "iyi yanıt verenler" (İY) ve "yetersiz yanıt verenler" (YY) olarak iki gruba bölünerek karşılaştırılmıştır.Bulgular: YY grubunda İY grubuna göre anksiyete bozuklukları sıklığı ve ortalama içevurum skorları anlamlı olarak daha yüksek, öz-kavramı skoru ise anlamlı olarak daha düşük bulunmuştur. Çoklu regresyon analizinde eşlik eden anksiyete bozukluğu, eşlik eden dışa atım bozukluğu varlığı ve olumsuz öz-kavramı düşük MTF yanıtının öngörücüleri olarak bulunmuştur.Sonuç: Bu çalışmanın sonuçları DEHB'ye eşlik eden anksiyete bozukluğu, inkontinans veya olumsuz öz-kavramı varlığında MTF tedavisine ek tedavi seçeneklerine ihtiyaç olduğunu göstermektedir

Factors Related to Methylphenidate Response in Children with Attention Deficit/ Hyperactivity Disorder: A Retrospective Study

Factors related to methylphenidate response in children with attention deficit/ hyperactivity disorder: a retrospective studyObjective: We aimed to explore the predictive value of clinical features and self-concept on methylphenidate (MPH) response in children with attention deficit/hyperactivity disorder (ADHD).Methods: The study had a naturalistic design where the results were analyzed retrospectively. ADHD and comorbidity were diagnosed by Schedule for Affective Disorders and Schizophrenia for School-Age Children Present Lifetime Version (K-SADS-PL). At the baseline assessment, parents completed Turgay DSM-IV Disruptive Disorders Rating Scale (T-DSM-IV-S) and Child Behavior Check List (CBCL); teachers were given T-DSM-IV-S, CBCL. The children completed Piers-Harris Children’s Self-Concept Scale (PHSCS), Children’s Depression Inventory (CDI), and Screen for Child Anxiety Related Emotional Disorders (SCARED). Following 4-8 weeks of MPH treatment, the parents completed T-DSM-IV-S and the clinician completed Clinical Global Impression-Improvement scale (CGI-I). This study included 54 children (18 girls, 36 boys; mean age 9.32±0.21 years old). The sample was divided in “good responders” (GR) and “poor responders” (PR) regarding the response criteria defined by authors.Results: The PR group had significantly higher rates of anxiety disorders, higher internalizing scores and lower PHSCS scores compared to GR. Comorbid anxiety disorders, elimination disorders and negative selfconcept were found to predict poor MPH response by multiple regression analysis. Conclusions: The results point to the need for additional interventions in the presence of comorbid anxiety, incontinence or poor self-concept in children with ADHD

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